Dear Editor,

The article ‘Correlation between clinical findings and eosinophil/neutrophil ratio in patients with nasal polyps’ by Hancer Tecimer et al. [1] is very interesting and well written. It, however, does provoke some controversy, which I would like to highlight. There is a slight flaw in the study design, which may have affected the results of the study. The groups differ in the treatment they have received, that is, the number of patients who underwent surgery or continued medical treatment in both the groups are different, and this creates a ‘Treatment Bias’, which can affect the outcome of the study. There are also few unanswered questions like ‘Did the same surgeon operate all the patients?’, ‘Was the endoscopic grading done by the same person?’ There have been many studies, which have proven that presence of eosinophils is an adverse factor and correlates with higher recurrence of polyps and a worse outcome after surgery [2–4]. The equivocal result in this study may be due to a smaller sample size and the treatment bias of both the groups. The best way forward would be design a blinded randomized control trial in which both the groups receive the same treatment and are followed for at least a year, before a definite conclusion can be arrived.